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Clinical Challenge: Comedones on the Cheeks

A 79-year-old man presents for treatment of a forehead cyst that has been excised surgically, but an incidental examination finds multiple open comedones affecting both cheeks. The patient states that these have been present for a long time and he is not concerned about them. The patient's facial skin is sallow, thickened, and leathery. He worked outdoors for decades and ...